Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects

Zeitoune, Rachel; Mogami, Roberto; Koifman, Ana Célia Baptista; Lopes, Agnaldo José; Soares, Andréa; Martins, Rosangela Aparecida Gomes; Maioli, Maria Christina Paixão

doi:10.1080/16078454.2020.1833506

Cited by 4 publications

(7 citation statements)

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“…In patients suffering from COPD, not only will the diaphragmatic muscle reduce its excursion but will have a preference for the inspiratory position; in patients with chronic heart failure the diaphragm mass becomes thinner with smaller respiratory excursions [8, 51]. In patients with anemia, the right portion of the diaphragm has a greater excursion than the left area, the opposite compared to healthy subjects [52]. In healthy elderly subjects, the diaphragm muscle reduces its strength and the ability to induce effective intra-abdominal pressure by about 20–41%, decreasing the excursion efficiently.…”

Section: Movement Of the Diaphragm During The Eupneic Ventilationmentioning

confidence: 99%

The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine

Bordoni

Walkowski²,

Escher

et al. 2021

Complement Med Res

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The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient’s homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator’s hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function.

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Section: Movement Of the Diaphragm During The Eupneic Ventilationmentioning

confidence: 99%

The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine

Bordoni

Walkowski²,

Escher

et al. 2021

Complement Med Res

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show abstract

“…Interestingly, Zeitoune et al 14 reported that in adults with SCD, respiratory muscle strength was impaired even though diaphragm thickness via ultrasonography was similar compared to healthy controls. However, diaphragm excursion was higher in the SCD group 14 . These findings may suggest that there are potential differences in ventilatory strategies owing to structural and functional changes in the diaphragm.…”

Section: Introductionmentioning

confidence: 99%

“…However, diaphragm excursion was higher in the SCD group. 14 These findings may suggest that there are potential differences in ventilatory strategies owing to structural and functional changes in the diaphragm. However, diaphragm function has not been well-studied in children with SCD and whether it affects ventilatory parameters such as respiratory frequency (f R ) and tidal volume (V T ) during exercise is not known.…”

mentioning

confidence: 99%

“…10 Respiratory muscle function is also impaired and is particularly concerning because of the potential impact on ventilatory strategies and exercise tolerance. 12,13 Interestingly, Zeitoune et al 14 reported that in adults with SCD, respiratory muscle strength was impaired even though diaphragm thickness via ultrasonography was similar compared to healthy controls. However, diaphragm excursion was higher in the SCD group.…”

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confidence: 99%

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Diaphragm excursion correlates with performance and ventilation on the 6‐min walk test in children with sickle cell disease

Rock

Marchese

2023

Pediatric Pulmonology

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Introduction: Diaphragm function may be impaired in children with sickle cell disease (SCD). We hypothesized that diaphragm function is related to performance and ventilation on the 6-min walk test (6MWT).Methods: Respiratory muscle testing, diaphragm ultrasonography, and the 6MWT with portable gas analysis were performed on children with SCD and age-and sex-matched controls.Results: Fourteen children with SCD were enrolled. Comparisons were made between nine children with SCD (9.89 ± 2.93 years) and nine controls (10.33 ± 2.35 years). Diaphragm thickness at total lung capacity, thickening fraction, and excursion time during quiet breaths and deep breaths (DB), all normalized by forced vital capacity, were greater in children with SCD (p< 0.05 for all). 6MWT distance was shorter in children with SCD (450.87 ± 74.2 m vs. 579.22 ± 72.46 m, p = 0.01). Tidal volume (V T ), minute ventilation (V E ̇), and oxygen consumption (V O2 ̇) were also lower (p< 0.05 for all). DB excursion correlated positively with 6MWT distance (r = 0.648, p = 0.023) and negatively with rate of perceived exertion (RPE) (r = −0.759, p = 0.003). RPE correlated negatively with distance (r = −0.680, p = 0.015). DB excursion time correlated positively with distance (r = 0.611, p = 0.035), V T (r = 0.770, p = 0.009), V E ̇(r = 0.736, p = 0.015), and V O2 ̇(r = 0.751, p = 0.012).Conclusions: Increased diaphragm excursion may be a strategy used to relieve air hunger while longer excursion time may reflect compensations to increase lung recruitment. Further studies are needed to better understand how these mechanisms affect exercise tolerance in children with SCD.

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“…Diaphragm dysfunction is associated with dyspnea, decreased exercise endurance and quality of life 13 . Ultrasound is considered as an optimal tool to evaluate the diaphragmatic thickness and function in multiple diseases because of its high sensitivity and specificity, combined with zero radiation and low cost 14 – 17 . Ultrasound-assessed diaphragm dysfunction is reliable in early identifying diaphragm atrophy and stratifying patients’ risk of worse prognosis 18 – 22 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-assessed diaphragm dysfunction predicts clinical outcomes in hemodialysis patients

Zheng

Yin²,

Wang³

et al. 2022

Sci Rep

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Skeletal muscle atrophy is prevalent and remarkably increases the risk of cardiovascular (CV) events and mortality in hemodialysis (HD) patients. However, whether diaphragm dysfunction predicts clinical outcomes in HD patients is unknown. This was a prospective cohort study of 103 HD patients. After assessment of diaphragm function by ultrasonography and collection of other baseline data, a 36-month follow-up was then initiated. Participants were divided into diaphragm dysfunction (DD+) group and normal diaphragm function (DD−) group, according to cutoff value of thickening ratio (i.e. the change ratio of diaphragm thickness) at force respiration. The primary endpoint was the first nonfatal CV event or all-cause mortality. A secondary endpoint was less serious CV events (LSCEs, a composite of heart failure readmission, cardiac arrhythmia or myocardial ischemia needed pharmacological intervention in hospital). 98 patients were eligible to analysis and 57 (58.16%) were men. 28 of 44 patients(63.64%) in DD+ group and 23 of 54 patients (42.59%) in DD− group had at least one nonfatal CV event or death (p = 0.038). Compared to DD− group, DD+ group had significantly higher incidence of LSCEs (21 vs.14, p = 0.025) and shorter survival time (22.02 ± 12.98 months vs. 26.74 ± 12.59 months, p = 0.046). Kaplan–Meier analysis revealed significantly higher risks of primary endpoint (p = 0.039), and LSCEs (p = 0.040) in DD+ group. Multivariate hazard analysis showed that DD+ group had significantly higher risk of primary endpoint [hazard ratio (HR) 1.59; 95% confident interval (CI) 1.54–1.63], and LSCEs (HR 1.47; 95%CI 1.40–1.55). Ultrasound-assessed diaphragm dysfunction predicts clinical outcomes in HD patients.Trial registration: This study was registered with Chinese Clinical Trials Registry (www.chictr.org.cn) as ChiCTR1800016500 on Jun 05, 2018.

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Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects

Cited by 4 publications

References 46 publications

The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine

The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine

Diaphragm excursion correlates with performance and ventilation on the 6‐min walk test in children with sickle cell disease

Ultrasound-assessed diaphragm dysfunction predicts clinical outcomes in hemodialysis patients

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